We plan to continue our study of the fatal medical and behavioral consequences of drug use, namely fatal injuries. Continuing our long- established collaboration with the NYC Medical Examiner (ME) we will collect and analyze data from 1994-1997 on 2,800 acute drug overdoses, 8,400 homicides, 2,600 suicides, and 6,000 other fatal accidents. This sample, added to our current core data base of an equal number of cases will allow us to analyze 40,000 cases of fatal injuries over 8 years. In addition, we will use new sources of data that include medical examiner autopsy reports for pathology of overdoses and routine HIV test reports on all fatal-injuries as well as district attorney homicide investigation reports. Our four aims are: 1) We will continue to track the rates of homicides, suicides, fatal accidental overdoses, motor vehicle and other accidents in NYC in regard to use of cocaine, opiates, ethanol and other drugs of abuse. We will follow temporal and geographic trends both city-wide and at the community level-particularly in high-risk poor neighborhoods of the city. 2) We will systematically assess the underlying pathologic mechanisms- specifically cerebrovascular and cardiovascular lesions-of a large sample of acute cocaine and mixed cocaine-drug overdose deaths. 3) We will, in the first study of its kind, determine the rates of HIV seropositivity among fatal injuries as well as the demographic and drug abuse correlates of HIV seropositivity. 4)Using data from homicide investigations at the District Attorney's office we will study important differences in the circumstances of death, victim-perpetrator relationships, criminal histories, and antemortem behaviors of homicide victims under the influence of cocaine and victims not under the influence of cocaine. Although casual drug use may be declining in some regions of the nation, drug-related mortality in NYC remains extremely high. Moreover, our earlier data suggest that after years of relatively low rates of detection, opiates are increasingly being found in fatal injury cases, underscoring the need to study the role of both opiates and cocaine and to monitor HIV infection rates in these cases. The study is expected to both broaden and deepen our understanding of the fatal consequences of cocaine and opiate use. It will also generate important surveillance data on drug-related mortality on which public health policy decisions may be made.